The present invention relates to a process for reducing or quenching free radical concentration in irradiated ultra high molecular weight polyethylene (UHMWPE). More particularly, the present invention relates to rapid quenching of free radicals to avoid long term oxidative degradation in irradiated cross-linked ultra high molecular weight polyethylene used to construct orthopedic implants.
The replacement of destroyed or damaged human joints is one of the greatest achievements of Twentieth Century orthopedic surgery. However, total joint prosthesis, composed of various combinations of metal, ceramic, and polymeric components, continue to suffer from limited service lives.
UHMWPE is commonly used as an articulating, load-bearing surface in total joint arthoplasty. In the last decade, however, it has become apparent that wear debris from UHMWPE components may be a primary contributor to osteolysis, loosening and eventual failure of prosthetic joints. With steady increases in human life expectancy, there is a driving need to significantly increase the effective lifetime of a single implant. A desire to use prosthetic implants in younger patients is another strong incentive for improving the wear resistance of UHMWPE. As indicated below, the present invention discloses a process to improve long term wear characteristics of prosthetic implants made with UHMWPE.
When a human joint is destroyed or damaged by disease or injury, surgical replacement (arthoplasty) is normally required. A total joint replacement includes components that simulate a natural human joint, typically:
(a) a more-or-less spherical ceramic or metal ball, often made of cobalt chromium alloy;
(b) attachment of a xe2x80x9cstemxe2x80x9d, which is generally implanted into the core of the adjacent long bone; and
(c) a hemispherical socket which takes the place of the acetabular cup and retains the spherical ball. This hemispherical joint typically is a metal cup affixed into the joint socket by mechanical attachments and xe2x80x9cliexe2x80x9d with UHMWPE. In this way, the ball can rotate within the socket, and the stem, via the ball, can pivot and articulate.
One of the difficulties in constructing any device for implantation into the human body is the need to avoid adverse immune responses. The probability of a severe immune response is reduced when certain synthetic materials are used. For example, synthetic UHMWPE implants have minimal immunogenicity problems. However, the wear and breakdown of the UHMWPE components are known in the art to cause immunology-related problems.
Histologic studies have demonstrated that wear of UHMWPE from orthopedic inserts leads to several problems. First, tissue surrounding implants constructed with UHMWPE has been shown to contain extremely small particles of UHMWPE which range from sub-micron to a few microns in size. While large particles of UHMWPE appear to be tolerated by the body, as is the intact solid wall of the UHMWPE implant, the body apparently does not tolerate smaller particles of UHMWPE. In fact, the small particles of UHMWPE can cause powerful histiocytic reactions by which the body unsuccessfully attempts to eliminate the foreign material. Agents released during this process attack neighboring bone to cause xe2x80x9cwear debrisxe2x80x9d induced osteolysis. This in turn leads to loss of fixation and loosening of the prosthesis due to xe2x80x9cremodelingxe2x80x9d of the bone. The breakdown of UHMWPE during wear which leads to these adverse biological problems, can be due, in part, to degradation of polymer chains resulting from chemical oxidation of free radicals.
Numerous techniques have been proposed to improve wear resistance of UHMWPE in orthopedic implants. In these instances, however, many of the new versions of articulating polymers have generally failed to demonstrate significant reduction in wear and often prove to be inferior to conventional polyethylene. Recent attempts at improving wear properties of UHMWPE use special pressure/temperature processing techniques, surface treatments, formation of composites with high modulus fibers, and cross-linking via ionizing irradiation or chemical agents. Some of these attempts are summarized below.
1. Temperature/Pressure Treatments
Special thermal and pressure treatments have been used to increase physical performance and wear resistance of UHMWPE (e.g., U.S. Pat. Nos. 5,037,928 and 5,037,938). For example, xe2x80x9cHippingxe2x80x9d (Hot Isostatic Pressing), produces material alleged to comprise fewer fusion defects, increased crystallinity, density, stiffness, hardness, yield strength and resistance to creep, oxidation, and fatigue. Clinical studies, however, indicate that xe2x80x9cHippingxe2x80x9d treated UHMWPE may possess inferior wear resistance in comparison to conventional UHMWPE. The inferior wear resistance being due to increased stiffness which leads to increased contact stresses during articulation (Livingston et al., Trans. ORS, 22, 141-24, 1997).
Post-consolidation temperature and pressure treatment, such as solid phase compression molding (Zachariades, U.S. Pat. No. 5,030,402), have also been attempted. Zachariades utilized solid state processing to further consolidate and orient UHMWPE chains. Resistance to wear in orthopedic implants, however, was not improved.
2. Surface Treatments
Focusing upon the surface of UHMWPE components, attempts have been made to decrease wear by increasing smoothness and/or lubricity of the UHMWPE components surface. A group from Howmedica used a heat pressing technique to melt the articulating surface and remove machine marks from the surface of UHMWPE components such that the xe2x80x9cwearing inxe2x80x9d of rough machine marks could be avoided. This modification, however, resulted in delimination and high wear due to the fact that high articulation-induced stresses were located in regions where there was a sharp transition in crystalline morphology (Bloebaum et al., Clin. Orthop. 269, 120-127, 1991).
Andrade et al. (U.S. Pat. No. 4,508,606) suggested oxidizing the surface of a wet hydrophobic polymer surface to reduce sliding friction. The preferred means included applying a radio frequency glow discharge to the surface. With this technique, surface chemistries were altered by changing the time of gas plasma exposure and by altering the gas composition. The invention was proposed for the treatment of catheters to decrease surface friction properties while in a wet state. Similarly, Farrar (World Patent Application No. WO 95 212212) proposed using gas plasma treatments to cross-link the surface of UHMWPE and, thereby, increase its wear resistance. None of the plasma treatments, however, were practical because any perceived benefit would most likely wear away with articulation.
3. Composites
Because creep may be a contributor to UHMWPE wear, investigators have also included high modulus fibers in polyethylene matrices to reduce plastic deformation. (U.S. Pat. No. 4,055,862.) developed a xe2x80x9cpoly-to-carbon polyethylene compositexe2x80x9d which failed significantly via delimination. Recently, Howmedica reported that a PET/carbon fiber composite exhibited 99% less hip simulated wear than conventional polyethylene over ten million cycles. (Polineni, V. K. et al., J. 44th Annual ORS, 49, 1998.)
4. Cross-Linking
A. Ionizing Radiation Induced Cross-Linking
In the absence of oxygen, the predominant effect of ionizing radiation on UHMWPE is cross-linking. Cross-linking of UHMWPE forms covalent bonds between polymer chains which inhibit cold flow (creep) of individual polymer chains. Free radicals formed during irradiation, however, can exist indefinitely if termination by cross-linking or other forms of recombination do not occur. Furthermore, reacted intermediates are continuously formed and decayed. Exposure of these free radical species at any time (e.g., during irradiation, shelf-aging, or in vivo aging) to molecular oxygen or any other reactive oxidizing agent can result in their oxidation. Extensive oxidation leads to a reduction in molecular weight, and subsequent changes in physical properties, including wear resistance.
To reduce oxidation after gamma sterilization, some orthopedic manufacturers have implemented techniques to irradiate their materials under conditions that encourage cross-linking and reduce oxidation. These techniques include use of inert gas atmospheres during all stages of processing, use of vacuum packaging, and post sterilization thermal treatments. Specific examples of these techniques are given below.
Howmedica has developed various means for reducing UHMWPE oxidation associated with processing, i.e., the continual use of an inert gas during processing (see U.S. Pat. Nos. 5,728,748; 5,650,485; 5,543,471; 5,414,049; and 5,449,745). These patents also describe thermal annealing of the polymer to reduce or eliminate free radicals. The annealing temperature which is claimed (room temperature to 135xc2x0 C.), however, avoids complete melting of UHMWPE.
Johnson and Johnson has disclosed in a European patent application (EP 0737481 A1 ) a vacuum packaging method with subsequent irradiation sterilization to promote cross-linking and reduce short- and long-term oxidative degradation. The packaging environment can contain an inert gas and/or hydrogen to xe2x80x9cquenchxe2x80x9d free radicals. The cross-linking/sterilization method is claimed to enhance UHMWPE wear resistance (Hamilton, J. V. et al., Scientific Exhibit, 64th AAOS Meeting, February 1997; Hamilton, J. V. et al., Trans 43rd ORS, 782, 1997.).
Biomet""s World Patent Application No. 97/29787 discloses the gamma irradiation of a prosthetic component in an oxygen resistant container partially filled with a gas capable of combining with free radicals (e.g., hydrogen).
Oonishi/Mizuho Medical Company-Japan and other investigators from Mizuho Medical Company began cross-linking PE (polyethylene) by gamma irradiation in 1971 for their SOM hip implants. Since then, they have studied the effect of a wide range of sterilization doses up to 1,000 Mrad on the mechanical, thermal, and wear properties of UHMWPE. They have also studied the effects of different interface materials on wear and found that alumina or zirconia heads on 200 Mrad irradiated UHMWPE liners produced the lowest wear rates (Oonishi, H. et al., Radiat. Phys. Chem., 39(6), 495, 1992; Oonishi, H. et al., Mat. Sci: Materials in Medicine, 7, 753-63, 1966; Oonishi, H. et al., J. Mat. Sci: Materials in Medicine, 8, 11-18, 1997).
Massachusetts General Hospital/Massachusetts Institute of Technology (MGH/MIT) has used irradiation (especially e-beam) treatments to cross-link UHMWPE. These treatments reduced simulator wear rates of hip components by 80 to 95% in comparison to non-sterilized controls (see, e.g., World Patent Application 97/29793). This technology enables UHMWPE to be cross-linked to a high degree; however, the degree of cross-linking is dependent upon whether the irradiated UHMWPE is in a solid or molten state.
Orthopaedic Hospital/University of Southern California has disclosed patent applications which seek to increase the wear resistance of UHMWPE hip components using irradiation followed by thermal treatment, such as remelting or annealing (World Patent Application WO 98/01085). Using this method, UHMWPE cross-linking was optimized such that the physical properties were above ASTM limits.
BMG""s European Application (EP 0729981 A1) discloses a unique processing method for decreasing friction and abrasive wear of UHMWPE used in artificial joints. The method involves irradiating UHMWPE at a low dose to introduce a small number of cross-linking points. Irradiation is followed by uniaxial compression of melted material to achieve molecular and crystallite orientation. BMG""s material demonstrated a significant reduction in pin-on-disk wear, but the reduction was not as significant as with highly cross-linked versions of UHMWPE (Oka, M. et al., xe2x80x9cWear-resistant properties of newly improved UHMWPE,xe2x80x9d Trans. 5th World Biomaterials Congress, 520, 1966).
Importantly, for these methods, thermal annealing of the polymer during or after irradiation causes the free radicals (generated during irradiation) to recombine and/or form a more highly cross-linked material. Reducing or quenching free radicals is extremely important because a lack of free radicals can prevent significant UHMWPE aging.
B. Chemical Cross-Linking
Like irradiation cross-linking, chemical cross-linking of UHMWPE has been investigated as a method for increasing wear resistance. Chemical cross-linking provides the benefit of cross-linking while avoiding the degradative effects of ionizing irradiation.
The Orthopaedic Hospital/University of Southern California has submitted patent applications for cross-linking UHMWPE in order to increase wear resistance in orthopaedics (European Patent Application EP 0722973 A1), including a method wherein the cross-linking results in a material with a decreased crystallinity. Cross-linking is accomplished by irradiation in a molten state or photo cross-linking in a molten state, or cross-linking with a free radical generating chemical, and annealing the cross-linked polymer to pre-shrink it. Residuals from the chemical cross-linking reaction, however, are a regulatory concern and may contribute to long-term oxidative degradation.
It remains an object of the present invention, therefore, to provide a process for treating UHMWPE for use in orthopaedic implants such that the long-term wear properties of the UHMWPE are improved.
It is another object of the present invention to provide a process for treating UHMWPE for use in orthopaedic implants in vivo such that problems with the implants in situ are eliminated.
It is a further object of the present invention to provide a process for treating high energy beam irradiated UHMWPE so as to reduce or quench free radical concentration.
It is a further object of the present invention to provide a process for treating high energy beam irradiated UHMWPE with electromagnetic energy for reducing or quenching free radical concentration and promoting formation of cross-links.
It is a further object of the present invention to provide a process for treating high beam energy irradiated UHMWPE with mechanical wave energy for reducing or quenching free radical concentration and promoting formation of cross-links.
The present invention provides a process to reduce or quench free radical concentration in irradiation cross-linked UHMWPE. More specifically, the present invention utilizes electromagnetic or mechanical wave energy to rapidly and efficiently promote free radical combination and formation of cross-links in irradiated UHMWPE. In a first embodiment, free radical concentration is reduced or quenched by irradiating cross-linked UHMWPE with pure or intense infrared radiation. Treatment with infrared radiation may be performed under vacuum. Following irradiation, the UHMWPE is allowed to cool ideally in the presence of an inert gas. In a second embodiment, free radical concentration is reduced or quenched by exposing irradiated UHMWPE to mechanical wave energy, such as ultrasound.
In summary, the process of treating irradiated cross-linked UHMWPE with electromagnetic or mechanical wave energy provides a rapid and efficient method for reducing or quenching radical concentration. Furthermore, UHMWPE having a reduced free radical concentration is more resistant to long-term oxidative degradation, and is, therefore, more suitable for use in prosthetic implants.